Daily Health Policy Report

Friday, January 11, 2013

Last updated: Fri, Jan 11

KHN Original Reporting & Guest Opinion

Health Reform


Capitol Hill Watch


Public Health & Education

Health Information Technology

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

A Guide To Health Insurance Exchanges

Kaiser Health News staff writer Julie Appleby reports: "It seems like a simple idea: create new marketplaces, called 'exchanges,' where consumers can comparison shop for health insurance, sort of like shopping online for a hotel room or airline ticket. But, like almost everything else connected with the health law, state-based insurance 'exchanges' are embroiled in politics" (Appleby, 1/10). Read the story.

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Capsules: Is California Headed For State Vs. Counties Health Budget Battle?

Now on Kaiser Health News' blog, Sarah Varney reports: "After four years of massive budget cuts to California's public health insurance programs – and the voters' approval of a tax increase – Gov. Jerry Brown is laying down his scalpel. Brown presented his proposed budget for the coming year on Thursday, including an additional $350 million in funding for the state's Medicaid program and a cautiously emphatic endorsement of President Barack Obama's health care law: 'What President Obama did was historic and heroic,' said Brown, a Democrat, during a press conference in Sacramento, Calif., 'and I will be a good partner'" (Varney, 1/11). Check out what else is on the blog.

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Political Cartoon: 'Keep On Pushin'?'

Kaiser Health News provides a fresh take on health policy developments with "Keep On Pushin'?" by Signe Wilkinson.

Meanwhile, here is today's health policy haiku:


Moral selection
of what's best for patients is
beancounter constrained.
-John Hogle

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

CMS Approves 106 New ACOs

Among those that gained approval is the South Florida ACO, which has an integrated care model that includes 75 doctors and the Walgreens drug store chain.

The Hill: HHS Approves 106 New 'Accountable Care' Groups Under Health Law
A new program to improve the coordination of health care services got a big boost Thursday as the federal Medicare agency approved 106 new Accountable Care Organizations (ACOs). ACOs were created under President Obama's health care law with the goal of improving quality and lowering costs (Baker, 1/10).

Modern Healthcare: CMS Announces Over 100 New ACO Contracts
Medicare nearly doubled the size of one accountable care program as of Jan. 1 with 106 new ACO contracts that offer hospitals and doctors financial incentives to improve quality and slow health spending. The CMS announced its latest and largest round of accountable care organizations under the Medicare shared-savings program, which launched in April last year with 27 ACOs. Another 89 ACOs were named to the program last July. The Center for Medicare and Medicaid Innovation separately launched 32 Medicare ACOs known as Pioneers roughly one year ago. CMS said half of ACOs are physician-led and care for less than 10,000 Medicare enrollees. Jonathan Blum, the CMS acting principal deputy administrator and director for the center for Medicare, said it is too soon to release results from Medicare accountable care efforts launched last year (Evans, 1/10).

The Miami Herald: Miami Doctors, Walgreens Join Race For ACOs
With Walgreens joining insurers and hospitals in a race to reshape health care delivery in the country, a group of 75 doctors has become the first federally approved accountable care organization in Miami-Dade, Medicare officials announced Thursday. South Florida ACO and the drugstore chain were on a list of 106 groups receiving approval to offer integrated care that is intended to improve quality and lower health care costs, with the providers sharing in any savings (Dorschner, 1/10).

Georgia Health News: 'Accountable Care' Takes Big Leap In State
A federal agency on Thursday announced 106 new health organizations that will participate in a special Medicare "shared savings" program, and nine of them will serve Georgians. The groups are called "accountable care organizations"’ (ACOs), networks of physicians and other medical providers that seek to improve patient care and contain costs (Miller, 1/10).

Milwaukee Journal Sentinel: Marshfield Clinic, University Of Wisconsin Health Join Medicare
Marshfield Clinic and University of Wisconsin Health have won approval to participate in a Medicare program designed to test new ways of paying hospitals and doctors. ... Accountable care organizations are health systems, physician groups or both that accept responsibility for the cost and quality of care provided to a specific group of patients. The organizations are eligible to share in any savings from providing more efficient care, provided they meet specific quality targets. The goal is to give hospitals, doctors and other health care providers a financial incentive to provide quality care at a lower cost and to move away from the current system in which they are paid based on the volume and type of services they provide, what is known as fee-for-service (Boulton, 1/10).

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S.D., N.M. Governors Take Opposing Tacks On Medicaid Expansion

Meanwhile, a key Georgia Republican lays out her party's reasons for opposing expansion, while California releases its cost estimate. Also in the news, Ohio and the Obama administration clash over high-risk pool eligibility, while Utah's exchange appears to be in limbo.

The Associated Press: SD Governor Against Quick Medicaid Expansion Because Of Uncertainty Of Federal Funding
Gov. Dennis Daugaard decided against expanding Medicaid to cover thousands of additional low-income South Dakotans because he's uncertain the federal government can afford to pay the bulk of the cost, a state official told lawmakers Thursday. Deb Bowman, a senior adviser to the Republican governor, said Daugaard has decided against recommending an expansion of Medicaid for now, but the governor and lawmakers could decide to make that move later (Brokaw, 1/10).

The Associated Press: NM Governor Announces Plan To Expand Medicaid
New Mexico, a state that hovers near the top of national poverty and uninsured rankings, plans to follow provisions of a federal health care law to expand Medicaid to potentially provide medical services to 170,000 low-income adults, Republican Gov. Susana Martinez announced Wednesday. New Mexico will join at least 15 other states and the District of Columbia in broadening eligibility for the health care program under terms of a health care overhaul championed by President Barack Obama (Massey and Bryan, 1/10).

Georgia Health News: Medicaid Expansion: A Danger Or A Blessing?
Too much expense. Too few doctors. Too little trust in the feds. State Rep. Sharon Cooper (R-Marietta), who chairs the House Health and Human Services Committee, laid out her party's arguments Thursday against Georgia expanding its Medicaid program, as outlined by the health reform law (Miller, 1/10).

The Hill: Calif. Governor Says Medicaid Expansion Will Cost $350 Million
Participating in the Medicaid expansion in President Obama's signature healthcare law will cost California about $350 million, according to the budget Gov. Jerry Brown (D) released Thursday. The costs to the state come mostly from people who are eligible for the program now but not enrolled, and are expected to join once the high-profile expansion takes effect (Baker, 1/10).

Politico: Feds, Ohio Clash Over High-Risk Pool Eligibility
The Obama administration and Ohio's insurance regulator are locked in a fight over whether to dump people from the health insurance pool for some of the state's sickest residents — and they're not taking the sides you'd expect. In fact, it's the overseers of Obamacare who want to cut off health insurance for 14 people — and it's the state of Ohio that wants to keep them covered (Millman, 1/11).

Stateline: Utah's Health Insurance Exchange In Limbo
Since the Affordable Care Act became law in 2010, states have known they would have a choice about whether to run their own health insurance exchanges or let the federal government do it for them. But with only eight months left before those online marketplaces are expected to open to the public, Utah hasn’t made up its mind. Utah is one of several Republican-led states weighing an eleventh-hour decision about whether to set up a state-run exchange. But it is a special case because it is one of only two states, the other being Massachusetts, that already has a functioning insurance exchange. In both states, the exchange was the brainchild of a Republican governor eager to promote free market competition. But once the concept became integral to the success of President Obama's federal health law, Utah and many other Republican-dominated states resisted it (Vestal, 1/11).

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Small Businesses, Individuals May Experience Sticker Shock Over Health Insurance Premiums

Politico reports that some insurance companies that sell policies to small businesses and individuals are already factoring in health law fees that will kick in in 2014. Meanwhile, the Wall Street Journal notes that some big insurers are moving "cautiously" toward state-based health exchanges.

Politico: Insurers' 2014 Hikes Already Taking Toll
If you work for a small business, your next health insurance premium may give you sticker shock. Many of the small-business and individual insurance policies are working the health reform law's 2014 fees into their 2013 bills, contributing to double-digit premium increases for some people (Haberkorn, 1/11).

The Wall Street Journal's MarketBeat: Big Health Insurers Aim Cautiously – For New Exchanges
Some of the biggest health insurers confirmed goals this week to offer plans over state-based exchanges set to launch late this year, but they're moving cautiously while waiting to learn more about these new markets (Kamp, 1/10).

Kaiser Health News: A Guide To Health Insurance Exchanges
It seems like a simple idea: create new marketplaces, called 'exchanges,' where consumers can comparison shop for health insurance, sort of like shopping online for a hotel room or airline ticket. But, like almost everything else connected with the health law, state-based insurance 'exchanges' are embroiled in politics" (Appleby, 1/10).

PoliticoPro: Commerce Blasts ACA's 'Regulatory Flood'
Although President Barack Obama’s health care law could help some low-income workers and their employers, U.S. Chamber of Commerce President Tom Donohue says that's just not worth the flood of new regulations and the extra cost to states. Giving his annual "State of American Business" address Thursday morning, Donohue cast much of the blame for what he calls a "regulatory flood" on the Affordable Care Act (Cunningham, 1/10).

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Obama Signs Bill Changing How Medicare Collects Money In Negligence Cases

The bill had bipartisan support and could help beneficiaries who sometimes wait months for injury-related settlements.

Politico Pro: Obama Signs Medicare Secondary Payer Overhaul
President Barack Obama signed legislation Thursday intended to simplify a complex and convoluted process that has caused Medicare patients to wait months for injury-related settlement checks. The new law's backers say patients have died or seen their homes foreclosed while waiting for settlement checks as a result of the existing process (Cheney, 1/10).

The Hill: Obama Signs Medicare Bill
Rep. Tim Murphy (R-Pa.) took a victory lap Thursday as President Obama signed a bipartisan Medicare bill. The legislation changes the way Medicare collects money from people whose negligence caused a patient to incur medical bills (Baker, 1/10).

In other Medicare news --

MedPage Today: MedPAC Again Backs SGR Repeal
The Medicare Payment Advisory Commission (MedPAC) will ... take Congress to the woodshed on the sustainable growth rate (SGR) formula by yet another demand for repeal and replacement of that universally reviled payment scheme. That recommendation will be delivered in MedPAC's annual report to Congress, which is set for March 15. The commission, which advises Congress on Medicare payment issues, made the same proposal in an October 2011 letter to lawmakers. MedPAC has voted to repeal the SGR since as early as 2001. "We think that left as it is, the SGR will only grow as an increasing threat to access to care with Medicare beneficiaries," MedPAC Chair Glenn Hackbarth, JD, said during Thursday's meeting (Pittman, 1/10).

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Capitol Hill Watch

Sen. Jay Rockefeller To Retire At End Of Term

KHN tracked news coverage Friday of the announcement by Sen. Jay Rockefeller, D-W.Va., that he will pass on making a bid for a sixth Senate term.

N.Y. Times: Senator Rockefeller Is Retiring After Five Terms
Senator John D. Rockefeller IV of West Virginia, the scion of the Rockefeller family who established himself as a liberal voice in Congress, said on Friday that he would retire in 2014 at the completion of his fifth term in the Senate (Weisman, 1/11).

National Journal: Jay Rockefeller Retirement Brings The Old Money, Big Fame Era To An End
Rockefeller toyed with running for president in 1992 but he was a man of the Senate, making a mark in health care where he co-authored the leading children's health insurance program and the regulation of telecommunications. He had Pat Moynihan’s knack for balancing national affairs and constituent services. Teamed with former Senate Majority Leader Robert Byrd, the two funneled billions back home (Cooper, 1/11).

USA Today: Rockefeller's Retirement Sparks Battle For Senate Seat
As a senator, Rockefeller is known for his work on health care and as the co-author of the Children's Health Insurance Program. During the most recent fight over health care, Rockefeller was a champion of the "public option," a government-run health insurance program. It did not make it into the final version of Obama's health care law (Camia and Kucinich, 1/11).

Charleston Gazette: Rockefeller Won't Run For Senate In 2014
He said his decision was motivated by considerations of family, and not because of an election challenge from Rep. Shelley Moore Capito, R-W.Va., who announced shortly after November's election that she would run for Rockefeller's Senate seat in 2014. West Virginia has voted increasingly Republican at the presidential level, and political observers predicted a close race between the two, partly because of Rockefeller's support for President Obama and his health care reform law (Nyden, 1/11)

The Associated Press/ABC News: Rockefeller Won't Seek Re-Election
Rockefeller defended his support of Obama and the president's signature health care overhaul, and insisted that their unpopularity with West Virginians did not influence his decision to retire. "I'm proud of that work, and if people don't like it, the more it comes into effect the more they will understand that it's good," he said of the health care reform (Messina and Raby, 1/11). 

The Hill: Sen. Rockefeller To Retire, Giving GOP A Prime Pickup Opportunity
Rockefeller is in his fifth term and was first elected to the Senate in 1984. The 75-year-old senator had long been considered a retirement risk for Democrats. Speculation about his plans mounted last June when he blasted the coal industry — the lifeblood of West Virginia’s economy — for resisting greenhouse gas regulations (Jaffe, 1/11).

Politico: Jay Rockefeller Retirement A Boon To GOP
Democrats hold a major registration advantage and control the state House, Senate and governorship. But voters have increasingly soured on national Democrats: President Barack Obama lost all 55 West Virginia counties and pulled just 36 percent of the vote. A federal prison inmate garnered 42 percent of the vote against Obama in the state’s Democratic presidential primary (Hohmann and Schultheis, 1/11).

Washington Post: The End Of The Rockefeller Political Dynasty?
The decision by Sen. Jay Rockefeller (D-W.Va.) to retire in 2014 means the nation will likely be without a Rockefeller in high office for the first time in four decades and just the second time since the 1950s (Blake, 1/11).

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IOM To Recommend Improvements In End-Of-Life Care; Physicians Slow To Report Quality Measures To Medicare

Two articles examine different efforts to improve medical care.

San Jose Mercury News: National Institute Of Medicine Will Recommend Ways To Improve End-Of-Life Care
In a national move that portends improvement of care for the dying, an expert panel assembled by the Washington, D.C.-based Institute of Medicine announced Thursday that it will recommend ways to improve end-of-life care in America. The Institute, part of the prestigious National Academy of Sciences, seeks changes in federal policy, financing and hospital practices that will bring care into line "with individual values and preferences to promote high-quality, cost-effective care at the end of life," according to a statement (Krieger, 1/10).

Medscape: Physicians Must Hustle To Avoid Reporting Penalty
Introduced in 2007, (Medicare's Physician Quality Reporting System) gives clinicians cash bonuses for telling the Centers for Medicare & Medicaid Services (CMS) how they score on clinical measures such as the percentage of final fluoroscopy reports that document radiation exposure or exposure time or the percentage of adult patients with diabetes whose most recent hemoglobin A1c reading exceeds 9%. Clinicians choose a handful of measures to report from a menu of several hundred. At least for now, it is pay-for-reporting, not pay-for-performance, which involves meeting certain score thresholds. The average individual bonus in 2010 was $2157. In 2015, the cash bonuses are replaced by a penalty equal to 1.5% of Medicare charges, which CMS will impose on physicians and other clinicians who do not successfully report quality data for 2013. The article projects that average penalties for radiologists in 2015 will range from $1991 for diagnostic radiologists to $6029 for radiation oncologists. ... What lends extra urgency to this warning are the low rates of participation so far in PQRS (Lowes, 1/10).

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Public Health & Education

This Year's Flu Season Could Add To Economy's Woes

Economists are predicting that this year's unusually early and strong flu season could be a drain on the current quarter's GDP numbers.

Marketplace: Flu Season Could Cost Economy Billions
The flu came early and it came on strong this year and that could weaken an economy that's not in the best of health as it is. The Centers for Disease Control says your typical flu season -- and this may not be -- costs employers over $10 billion, just in direct doctor and hospital visits alone. The $10 billion doesn't even count lost productivity. Economists say an exceptionally strong flu season could undercut an already struggling U.S. economy (Gardner, 1/10).

The New York Times: Children's Flu Medicine In Short Supply
Pharmacies around the country have reported dwindling supplies of liquid Tamiflu, a prescription flu medicine that can ease symptoms if taken within 48 hours of their onset. The drug is available in capsules for adults and a liquid suspension for children and infants. “There are intermittent shortages of the liquid version (but not the capsule version) due to the supplier’s challenges to meet the current demand,” Carolyn Castel, a spokeswomen for CVS Caremark, said (O'Connor, 1/10).

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Health Information Technology

Analysis: Conversion To EHRs Having Mixed Results -- At Best

The New York Times: In 2nd Look, Few Savings From Digital Health Records
The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation (Abelson and Creswell, 1/10).

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State Watch

Texas, Planned Parenthood Continue Legal Battle

Arguments will be held today regarding the organization's participation in the Texas Women's Health Program. In other news, attorneys for Hobby Lobby -- which has been a staunch opponent of the health law's birth control mandate -- says the company has found a way to delay complying with this requirement.

Texas Tribune: Planned Parenthood, State Back In Court For Hearing
Planned Parenthood and the state of Texas will continue their legal battle Friday over the organization's ability to participate in the Texas Women's Health Program. Travis County District Judge Stephen Yelenosky will hear arguments on whether to grant a permanent injunction allowing Planned Parenthood to participate in the state-funded program until a trial can be held to determine the validity of the state's Affiliate Ban Rule (Aaronson, 1/11).

CNN: Planned Parenthood Seeks Injunction In Texas Funding Law
Planned Parenthood in Texas heads to federal court Friday, looking for a temporary injunction that would allow it to take part in the state's revamped Women's Health Program. Late last month, a Texas judge denied the group's request for a temporary restraining order that would have extended the organization's ability to participate. A state law that went into effect with the new year requires the state to fully fund women's health clinics with the exception of those that are affiliated with abortion providers. With that new law, Texas is no longer eligible for federal funding for women's health and, therefore, Planned Parenthood and other such establishments in the state will no longer be able to receive federal funding (Kuo, 1/11).

The Associated Press/Washington Post: Hobby Lobby Attorney Says Okla. Firm Can Delay Birth-Control Requirement Of Health Care Law
An attorney for Oklahoma City-based Hobby Lobby says the company has found a way to delay providing insurance coverage for emergency contraceptives as required under the federal health care law. Peter Dobelbower said in a statement Thursday that the company will shift the plan year for employee health insurance that will delay by several months the Jan. 1 effective date of the requirement (1/10).

Meanwhile, Virginia Attorney General Ken Cuccinelli offers advice to other opponents of this health law provision --

Politico: Ken Cuccinelli: 'Go To Jail' To Fight Contraception Mandate
A devout Catholic, Cuccinelli told Deace that opponents of the mandate should put the controversial measure on trial by making the government enforce it in as heavy-handed a way as possible (Burns, 1/10).

The Associated Press/Washington Post: On Iowa Radio, Cuccinelli Says Jail May Be A Fitting Protest To Feds' Contraception Mandate
Virginia Attorney General Ken Cuccinelli said on a syndicated radio program that going to jail may be an effective way to protest a federal mandate that employers cover contraceptives in insurance plans. On Iowa conservative radio host Steve Deace's Wednesday night show, the Republican gubernatorial candidate and tea party favorite said civil disobedience is one way to attack the Affordable Care Act requirement now being challenged in a federal lawsuit by the Hobby Lobby stores (1/10).

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State Highlights: Mental Health Reforms Take Shape In Kan., Colo.

A selection of health policy stories from New York, California, Kansas, Colorado, Wisconsin, Florida and Georgia.

Los Angeles Times: Gov. Jerry Brown Commits To Major Medi-Cal Expansion
Brown earmarked $350 million in his spending plan to help enroll more Californians in Medi-Cal, the state's health insurance program for the poor. Under the proposal, enrollment rules would be simplified to cover residents who are currently eligible but not enrolled. Those costs would be split evenly between state and federal governments. The governor's plan also calls for a separate, larger expansion of Medi-Cal that would cover a group of low-income Californians not currently eligible for the program: adults without children, earning up to 138 percent of the federal poverty level -- or $15,415 a year. The federal government would subsidize costs for the first three years, with the state shouldering a portion of the bill after that (Mishak, 1/10).

Los Angeles Times: Brown's Budget Proposal Has Good News For Some
California would significantly expand public health insurance under Brown's proposed budget as part of a plan to implement President Obama's health care overhaul. … Brown earmarked $350 million to help enroll more Californians in Medi-Cal, the state's health insurance program for the poor. The cost would be split between the state and federal governments (1/10).

California Healthline: Budget Called A 'Godsend' For Health Care Community
California Health and Human Services Secretary Diana Dooley summed up the health care impact of yesterday's budget proposal this way: "The good news is, there are no cuts," Dooley said. "While we are not restoring anything, we are not cutting, either." That was a tremendous relief to Senate member Ed Hernandez (D-West Covina), chair of the Senate Committee on Health. After enduring year after year of multi-billion-dollar cuts to health programs, he said no budget news is good budget news. … Even with the lack of cuts, there were still a number of items in the proposed budget that could have a significant impact on the health care system (Gorn, 1/11).

Kansas City Star: Brownback Says Kansas Will Spend $10 Million For At-Risk Mentally Ill
Gov. Sam Brownback -- prompted in part by December's massacre at Sandy Hook Elementary School -- said his administration will spend $10 million to treat Kansas' most serious cases of mental illness. At a news conference Thursday in Kansas City, Kan., the Republican said improving treatment for the most at-risk mental health patients will be an immediate step to try to prevent tragedies like that in Newtown, Conn., where 26 students and teachers were murdered, and in [Littleton], Colo., where 12 high school students and one teacher died in a shooting rampage. "We haven't made much progress since Columbine in getting at these shocking types of cases," Brownback said. "What we're picking here is a piece I think we can move forward on" (Helling, 1/10).

Kansas Health Institute: Governor Announces New Mental Health Initiative
Gov. Sam Brownback today described the broad outline of a new mental health initiative that he said would focus on the development of regional hubs to target services toward mentally ill persons who resist treatment until a crisis forces them into a mental hospital or prison. He and other administration officials acknowledged the plan was prompted in part by the Newtown, Conn. school shooting last month that left 20 children and six adults dead after an apparently deranged and heavily armed man attacked Sandy Hook Elementary (Shields, 1/10).

Modern Healthcare: Colo. Governor Seeks To Overhaul Mental Health System
Colorado Gov. John Hickenlooper's state of the state address included a moment of silence for the 12 people who were shot and killed in an Aurora, Colo., movie theater July 20 and a call for a "comprehensive overhaul of the state's mental health system." "We have to do a better job of identifying and helping people who are a threat to themselves and others," Hickenlooper said in his speech. "We ask you to pass legislation that will update civil commitment laws, make it easier to identify people with mental illness who are a danger to themselves and others and provide safer, more humane systems for their treatment." Last month, Hickenlooper outlined an $18.5 million five-point plan to strengthen to the state's mental health system (Robeznieks, 1/10).

Denver Post: Patrick Kennedy Calls For Mental Health Insurance Reforms In Colorado
Colorado must reform laws and insurance benefits to give patients and families access to mental illness treatment equal to what as they usually get for medical treatment, panelists at an informal "hearing" said Thursday night. The mental health community has waited more than four years since passage of a federal parity in treatment act for a final set of rules to be issued, and the time is far past due, said former U.S. Rep. Patrick Kennedy and other speakers. Telling patients to walk "down the hall" to get mental health care, if they can get it at all, is the same as telling black Americans in the 1960s to walk down the hall to the "colored" fountain, Kennedy said. "It's long past time we as a nation move into the 21st Century," Kennedy said, and ensure mental illnesses "no longer get segregated and dismissed as character issues rather than chemistry issues" (Booth, 1/10).

The New York Times: New York City To Restrict Prescription Painkillers In Public Hospitals' Emergency Rooms
Some of the most common and most powerful prescription painkillers on the market will be restricted sharply in the emergency rooms at New York City's 11 public hospitals, Mayor Michael R. Bloomberg said Thursday in an effort to crack down on what he called a citywide and national epidemic of prescription drug abuse (Hartocollis, 1/10).

Milwaukee Journal Sentinel: Health Care Job Openings Dwindle
Job openings for nurses, pharmacists, radiology technologists and other jobs in health care are near historic lows, according to a report released Thursday by the Wisconsin Hospital Association. The number of openings four or five years ago ran into the double digits. "The employment picture has changed," said Judith Warmuth, vice president-workforce at the Wisconsin Hospital Association. The slow economic recovery and high unemployment rate had a part in this. But schools throughout the state responded to the nursing shortage by significantly expanding their programs. ... The University of Wisconsin-Milwaukee doubled the size of its undergraduate nursing program at the height of shortage in the last decade. The university graduated 100 nurses from its undergraduate program and 50 from its graduate programs last month (Boulton, 1/10).

The Associated Press: Florida Enhances Program For Disabled Children
Florida is enhancing its efforts to get severely disabled children out of nursing facilities and back home, though the head of the state agency that oversees their care said Thursday she couldn't find the conditions that are being criticized by families and federal officials. The accusations come from families of more than a dozen children who have filed a lawsuit and the Department of Justice, which also has threatened to sue the state (Kaczor, 1/10).

The Associated Press: Georgia Speaker: Guard Health Care, Change Lobbying Rules
House Speaker David Ralston has broadly endorsed the idea of extending a high-profile hospital industry tax that generates a sizable portion of revenue for state health care. In a separate matter, the Blue Ridge Republican promised during a wide-ranging interview Thursday that he will push for changes to Georgia's ethics law, including broadening the definition of who qualifies as a lobbyist to bring more people under rules that govern interactions with elected officials (1/11).

Los Angeles Times: Restored Funding For Prescription Drug-Program Monitoring Program Urged
California Atty. Gen. Kamala D. Harris on Thursday called on Gov. Jerry Brown to restore funding to a prescription drug-monitoring program that health experts say is key to combating drug abuse and overdose deaths in the state (Girion and Glover, 1/11).

California Healthline: New Institute Hopes To Boost Primary Care Pay, Numbers In California
Calling primary care "the cornerstone for all of California's health care delivery systems" and "the foundation for every goal of health care reform," a new organization arrives in California next week hoping to give the profession a shot in the arm. The California Advanced Primary Care Institute brings together a wide spectrum of stakeholders with high hopes of reinvigorating a key part of the health care workforce in California. The state's primary care workforce will decline by about 30 percent over the next decade at the same time demand increases with millions of Californians gaining coverage through the Affordable Care Act (Lauer, 1/10).

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Health Policy Research

Research Roundup: Effectiveness Of Mobile Clinics; Can More Alternative Medicine Coverage Save Money?

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Mobile Clinic In Massachusetts Associated With Cost Savings From Lowering Blood Pressure And Emergency Department Use – Approximately 2,000 mobile health clinics in the U.S. have 6.5 million patient visits annually. Researchers analyzed data from nearly 6,000 patients from 2010 to 2012 from one program, to examine the clinical impact and cost-effectiveness and found: "Our pilot evaluation suggests that this model can be effective in supporting reductions in blood pressure in underserved communities. It also suggests that mobile clinics can be cost-effective as a delivery model for primary and secondary preventive care, based on savings from health improvement and emergency department avoidance. ... policy makers should consider mobile clinics as a delivery model for underserved communities with poor health status and high use of emergency departments" (Song et al, 1/2013). 

Health Affairs: US Spending On Complementary And Alternative Medicine During 2002-08 Plateaued, Suggesting Role In Reformed Health System – The authors write that complementary and alternative medicine services are "equal to 3 percent of national ambulatory health care expenditures, and the care "is primarily paid for out of pocket, although some services are covered by most health insurance. ... Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best." They conclude that if some forms of this medicine are proven "more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow" health spending growth (Davis, Martin, Coulter and Weeks, 1/2013).  

Kaiser Family Foundation: Implementing New Private Health Insurance Market Rules – Under the health law, significant changes in private health insurance are set to take place January 1, 2014. This new Kaiser Family Foundation issue brief "looks at three proposed federal regulations released in late November 2012 that detail how the ACA's rules will operate in the following areas: private insurance market reforms, essential health benefits and actuarial value, and wellness programs offered or required by employers under group health plans." The proposed regulations "deal with aspects of the ACA intended to promote broader risk pooling, prohibit discrimination based on health status, enhance insurance market efficiency and affordability, promote wellness, and improve consumer protections" (1/8).

Here is a selection of news coverage of other recent research:

Reuters: Fewer Americans Saw Doctors During "Great Recession"
Americans made fewer trips to their doctors' offices during the Great Recession than they did earlier in the decade, according to new research. "These are not dramatic drops, but in our healthcare system we're used to our numbers going up... So just seeing a reverse in the trend is interesting," said Karoline Mortensen, the study's lead author from the University of Maryland in College Park. Using a national database of medical expenses from about 54,000 people between the ages of 18 and 64 years old, Mortensen and her colleague compared how many times people of different races used health services during two-year periods before the recession (2005 and 2006) and during it (2008 and 2009) (Seaman, 1/9). 

Medscape: EHRs: Small Practices Need Sustained Technical Help
Only those physicians who received extensive, sustained, technical assistance with electronic health records (EHRs) had significant improvements in quality of care, according to a study published in the January issue of Health Affairs. This study of small physician practices in New York City also showed that quality improved only for a limited group of measures. "EHRs were once thought to be a cure-all for helping improve patient care, but there are implementation issues and the technology has a steep learning curve," lead author Andrew M. Ryan, PhD, assistant professor of public health at Weill Cornell Medical College, New York City, said (Barclay, 1/9).

Medscape: HPV Cancers Increase, Vaccination Rates Remain Low
A rise in cancers associated with human papillomavirus (HPV) in the United States is highlighted in the Annual Report to the Nation on the Status of Cancer, which was published online January 7 in the Journal of the National Cancer Institute. The authors of the report, as well as other experts, have used these data to emphasize the potential of the HPV vaccination. ... In 2010, 32.0% of American girls 13 to 17 years of age had received 3 doses of the HPV vaccine. Coverage was significantly lower than the national average in those without insurance (14.1%). It was also significantly lower in some of the Southern states (20.0%), which have the highest rates of cervical cancer and the lowest prevalence of recent Pap testing (Nelson, 1/9). 

Medscape: Physician Online Ratings Unreliable, Easily Skewed
Web site physician ratings are based on input from only 2.4 patients on average, according to a study published online December 10, 2012, in the Journal of Urology. "Our findings suggest that consumers should take these ratings with a grain of salt," said first author Chandy Ellimoottil, MD, urology resident from the Loyola University Medical Center in Maywood, Illinois, in a news release, noting that the ratings can be easily skewed by 1 or 2 very happy (or unhappy) patients, rendering them unreliable (Waknine, 1/9). 

MedPage Today: Study Reports Reflect Researchers' Bias
A third of randomized clinical trials (RCTs) in breast cancer had published results that showed bias in the reporting of endpoints, and two-thirds showed bias in reporting toxicity, authors of a literature review concluded. Of 164 studies included in the review, 54 (32.9%) had positive results that were not based on the primary endpoint, which was not statistically different (Bankhead, 1/10).

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Editorials and Opinions

Viewpoints: The Country's Deep Health Problems; Anthem's Rx Policy In Calif. May Not Be Legal; Wis. Gov. Medicaid Decision Looming

The New York Times: America's Health Disadvantage 
It is now shockingly clear that poor health is a much broader and deeper problem than past studies have suggested. An authoritative report issued by the Institute of Medicine this week found that, on average, Americans experience higher rates of disease and injury and die sooner than people in other high-income countries. ... The panel suggested a campaign to raise public awareness of the American health disadvantage and a study of what other countries are doing that might be useful here (1/10). 

The Wall Street Journal: Team Of Liberal Loyalists
It's notable how (Jack) Lew's reputation has changed during the Obama years. As White House budget director in the Clinton era, he was viewed by Republicans as a reasonable liberal they could do business with. But as budget director and chief of staff in the Obama White House, Mr. Lew has been the President's most partisan and implacable negotiator. Our sources who have been in the room with the 57-year-old say he is now a fierce defender of entitlements in their current form, resists all but token spending restraint, and favors higher tax rates (1/9). 

Los Angeles Times: Anthem's Mail-Order Policy May Have Crossed A Legal Line
Anthem Blue Cross may be breaking California law by requiring some policyholders to buy their prescription drugs from a single mail-order pharmacy, according to the state attorney general's office. ... it shouldn't be "my way or the highway," not when people's lives are on the line. Offer a discount for shopping at the pharmacy of Anthem's choosing, but don't punish people for going to the same drugstores that all other members are free to use (David Lazarus, 1/10).

USA Today: Retirees Face Their Own 'Fiscal Cliff' 
One group with a darker financial future is older Americans. With some new twists to old-fashioned retirement saving plans, Americans can fill some gaps we can expect as Social Security, Medicare and other safety net programs get recast (Ted Fishman, 1/10). 

The Washington Post: FDA Should Revamp Nutrition Labels
Millions of health-conscious people consider nutrition labels essential when they buy food, but the labels are showing their age. Improving food labels could spur companies to market much healthier foods and encourage consumers to make smarter choices. One problem is that because of advances in nutrition research since 1993, calories and refined sugars are considered more important today, and concern has shifted from total fat to saturated and trans fats (Michael F. Jacobson, 1/10).

Milwaukee Journal Sentinel: Walker's BadgerCare Decision
Of all the decisions Gov. Scott Walker is likely to make in 2013, none will have a bigger impact than whether Wisconsin accepts over $12 billion in federal health care reform money over the next decade to fill the holes in BadgerCare. ... It will guarantee hundreds of thousands of working Wisconsinites the freedom to control their own health care decisions, create thousands of 21st-century jobs in the health care professions and actually save the state budget hundreds of millions of dollars. It would be nothing short of public policy sabotage to turn the money down for the narrow partisan purpose of undermining the health care reform law. Yet Walker seems poised to do so (Robert Kraig, 1/9).

Reuters: How To Improve Vaccination
The cost of [the current flu epidemic] is going to be enormous, both in dollars and in lives, and there’s a limited number of things that anybody can do to slow it down. ... Vaccination isn’t perfect — as we’re discovering right now. Especially with respect to influenza, which comes in a dizzying variety of flavors, a vaccine can’t prevent an outbreak every year. But vaccination has proved itself time and time again as being the most ambitious and effective solution to public-health problems that the world has ever seen (Felix Salmon, 1/10). 

New England Journal of Medicine: Post-Hospital Syndrome — An Acquired, Transient Condition Of Generalized Risk
To promote successful recovery after a hospitalization, health care professionals often focus on issues related to the acute illness that precipitated the hospitalization. Their disproportionate attention to the hospitalization's cause, however, may be misdirected. Patients who were recently hospitalized are not only recovering from their acute illness; they also experience a period of generalized risk for a range of adverse health events. Thus, their condition may be better characterized as a post-hospital syndrome, an acquired, transient period of vulnerability (Dr. Harlan M. Krumholz, 1/10).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.